Isabela Physical Therapy and Wellness Center

💠Plantar Fasciitis:-
Plantar fasciitis is the result of collagen degeneration of the plantar fascia at the origin, the calcaneal tuberosity of the heel as well as the surrounding perifascial structures.

🔵Symptons 🔵

The dull, constant ache. Sharp or stabbing pain when you use your affected foot or put pressure on your heel. Exercising or moving might temporarily relieve your pain, but it'll usually get worse as soon as you stop. Increased pain first thing in the morning or when you stand up after sitting or sleeping

💠Etiology:-

1)Reduced dorsiflexion and first metatarsophalangeal joint extension are weakly associated
2)Increased plantar flexion range[l
3)Pes cavus or pes planus deformities
4)Excessive foot pronation
5)Impact/weight-bearing activities such as prolonged standing, running, etc
6)Improper shoe fit
7)Elevated BMI
8)Presence of a sub calcaneal spur
9)Diabetes Mellitus
10)Leg length discrepancy
11)Tightness and/or weakness of Gastrocnemius, Soleus, Tendoachilles tendon

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💠Diagnostic test

🔹Windlass Test - Passive dorsiflexion of the first metatarsophalangeal joint (test to provoke symptoms at the plantar fascia by creating maximal stretch), positive test if the pain is reproduced.(shown in 40-second video below)

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⬛◾Physical Therapy intervention◾⬛

◾Ice after activity as well as oral or topical

◾ Towel Stretch
Sit with your legs extended and knees straight.
Place a towel around your foot just under the toes.Hold each end of the towel in each hand, with your hands above your knees.Pull back with the towel so that your foot stretches toward you.Hold the position for at least 15 to 30 seconds.Repeat 2 to 4 times a session, up to 5 sessions a day.

◾Calf stretch

Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.
Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times.

◾Planter fascia Stretch

Stretching the plantar fascia and calf muscles can increase flexibility and decrease heel pain. You can do this exercise several times each day and before and after activity.

"Stand on a step as shown above. Be sure to hold on to the banister.Slowly let your heels down over the edge of the step as you relax your calf muscles. You should feel a gentle stretch across the bottom of your foot and up the back of your leg to your knee.Hold the stretch about 15 to 30 seconds, and then tighten your calf muscle a little to bring your heel back up to the level of the step. Repeat 2 to 4 times."

◾Tie curl

Make this exercise more challenging by placing a weighted object, such as a soup can, on the other end of the towel.

While sitting, place your foot on a towel on the floor and scrunch the towel toward you with your toes.Then, also using your toes, push the towel away from you.

◾Marble pickup

Put marbles on the floor next to a cup.
Using your toes, try to lift the marbles up from the floor and put them in the cup.

◾Planter fascia massage

Sit in a chair or stand with one foot resting on a small ball or frozen water bottle. A frozen water bottle is useful as the ice helps reduce inflammation.Gently roll the ball or water bottle forward and backward under your foot. Start at just below the ball of your foot and end just before your heel.Roll the ball or bottle back and forth slowly 10 times for each foot. Do two sets per foot.
Do this exercise once daily.

◾Heel raises

Stand with the balls of your feet at the edge of a bottom step.With your heels hanging off the edge, slowly and gently lower your heels just below the edge of the step. You may feel a stretch in your calf muscle.
Slowly rise onto the balls of your feet.
Repeat this 10 times, then rest. Complete two sets of this exercise.
Do this exercise once daily.

◾Floor Sitting Ankle Inversion With Resistance
Note: This exercise requires an elastic exercise band.

Sit upright on the floor with your legs straight out in front of you. Make sure to avoid any hip movement while doing this exercise.
Place your left leg over your right leg with a resistance band secured around your upper foot and looped around the bottom of your lower foot. Hold the end of the band in your hand.Slowly move your upper foot (the one with the resistance band around it) away from the lower foot. To do this, rotate your ankle inward and slowly return it to the starting position.Repeat 10 times and complete two sets per foot.
Do this exercise once daily

◾Seated Plantar Fascia Stretch

Note: Complete this stretch in a slow and controlled manner.

Sit in a chair and cross one leg over the other knee, so your ankle is on top of your other leg.
With one hand holding your ankle and the other holding your toes, gently pull your toes backward until you feel a stretch in the bottom of your foot.Hold this position for 20 seconds and repeat three times for both feet.
Do this exercise once daily

◾NSAIDs can be used to help alleviate pain.
➖Naproxen
➖Diclofenac
➖piroxicam
➖lornoxicam

◾Deep friction massage of the arch and insertion.

◾Shoe inserts or orthotics and night splints may be prescribed in conjunction with the above.

⚡⚡Electrotherapy ⚡⚡

◾Needling Therapies (Acupuncture)
◾Low-Level Laser Therapy (LLLT)
◾Prolotherapy
◾Iontophoresis
◾K.Taping should prevent pronation.Low dye is the most commonly used taping technique and can improve pain in the short term

◾Foot orthoses can be prefabricated or custom. They must support the medial longitudinal arch and provide cushioning to the heel

💠Surgical treatment
◾Endoscopic Plantar Fasciotomy

💢 A quadriceps strain, also known as a quad strain, is an injury that affects the quadriceps muscles located at the front of the thigh.

The quadriceps muscles are responsible for extending the leg and are commonly used during activities such as walking, running, jumping, and squatting.

A strain occurs when the muscle fibers of the quadriceps are stretched or torn, usually due to overuse, sudden movements, or excessive force applied to the muscle.

Athletes, particularly those involved in sports that require explosive leg movements, are more prone to quadriceps strains.

Symptoms of a quadriceps strain may include pain or tenderness in the front of the thigh, swelling and bruising, difficulty in straightening the leg or performing activities that involve bending the knee, weakness or a feeling of tightness in the quadriceps muscle, and in severe cases, a popping or tearing sensation may be felt at the time of injury.

Treatment for a quadriceps strain typically involves rest, ice therapy, compression, elevation, and pain medication.

Physical therapy exercises and stretching are also important to regain strength and flexibility in the affected muscle.

In more severe cases, a brace or crutches may be necessary to aid in walking and allow the muscle to heal.

It is important to seek medical attention for a proper diagnosis and to receive appropriate treatment for a quadriceps strain.
Achieve Physical Therapy & Performance ✍️✍️

COCCYDENIA coccalgia, coccygeal neuralgia or tailbone pain, is the term used to describe the symptoms of pain that occur in the region of the coccyx.The pain is most commonly triggered in a sitting position, but may also occur when the individual changes from a sitting to standing position.

✨Ergonomic Adjustments✨
The initial goal of treatment should be focused on providing postural education.Individuals should be taught to correct their sitting posture by sitting more erectly on a firm chair.A proper sitting posture ensures weight is taken off the coccyx and is instead loaded onto the ischial tuberosities and the thighs.Patients should be advised to avoid any positions or movements that might exacerbate their symptoms.

"Physiotherapists may also recommend the use of cushions. Modified wedge-shaped cushions (coccygeal cushions), which can be purchased over the counter, help to relieve the pressure placed on the coccyx during sitting. Donut shaped or circular cushions may also be used"

⚽Manual Therapy:-
The manual therapy techniques suggested in the literature range from massage, stretching, mobilization and manipulation, and may either involve internal or external contact with the coccyx.

〽Internal adjustment:-
Internal techniques may include massage of the levator ani muscle or the coccygeus muscle,joint mobilization while the coccyx is hyperextended to stretch the levator ani, or repeated mobilizations while the coccyx is rotated.
〽External adjustment:-
External techniques may include manipulations of either the coccyx or sacroiliac joint, mobilizations of the sacrococcygeal or intercoccygeal joints, posterior mobilizations to the thoracic spine, and stretching of the piriformis or iliopsoas.

♦Mobilization techniques may be the preferred technique when the goal of treatment is to increase coccygeal mobility.Pelvic floor rehabilitation can be helpful for coccydynia that is associated with pelvic floor muscle spasms

🔹TENS
During TENS, your device delivers a light electrical current that disrupts pain signals from the coccyx to the brain. This solution is ideal for pain management, but tends to wear off several hours after treatment
🔹Ultrasound therapy
(5days per week for about 4week )

◾Exercise to avoid:-
Exercises that put pressure on it - Spin class, Pilates roll ups/rolling like a ball/balancing with your legs lifted, Barre class where you are instructed to tuck. Tightness in the hip rotators and pelvic floor muscles. Kegels - with a coccyx injury you have to be very careful with pelvic floor muscle strengthening.

💉Injection for tail bone:-
Coccygeal injection consisting of direct administration of steroid and local anaesthetic. Ganglion impar injection treats coccyx pain by blocking the pain signals to the brain, and these injections can be both diagnostic and therapeutic

🐋Knee to Chest Stretch:-
Raise the knees toward the ceiling, keeping the feet flat on the floor. Bend the left leg closer into the body and rest the left ankle across the right knee. Loop the hands around the right thigh and gently pull it toward the chest for 30 seconds.

🔳 Surgical options include:

Partial coccygectomy (removal of part of the coccyx — extremely rare).
Total coccygectomy (removal of the entire coccyx — extremely rare)

📎 Coccydynia in Pregnancy:-
because the growing fetus is putting pressure on the bone. Physical therapists recommend you lie on your side when you sleep and sit on a coccyx cushion. Both will help relieve some of the pain by taking pressure off of your coccyx

5 Tips for Buying Your Next Pair of Shoes

1️⃣ Shop for shoes at NIGHT, your foot can grow by up to 8% by the end of the day. Also, the heat of the summer may expand your foot.
2️⃣ Most people have one foot slightly longer than the other. Buy your shoes to match the longer foot.
3️⃣ Make sure to try your shoe on at the store with the same type of sock you will wearing.
4️⃣ Don't buy a longer shoe to make up for a shoe that feels too narrow, Your toes need room to move around.
5️⃣ Make sure to stand in your shoe. You should have about a quarter- to a half-inch of space between your longest toe and the end of the shoe.

More than anything you need to think about two things:

1. The condition of your feet.
2. What the shoe is for.

My wife once told me "Don't mess with the things that get your places."

We have to think of our shoes as part of a treatment plan. If you are someone who is, unfortunately, suffering from plantar fasciitis, you need to think about pain relief right away but have your goal be to never suffer from the pain again.

This means you may need to have an orthotic in your shoe that provides you with both support and cushioning but your long-term goal needs that you are able to wear a shoe that allows your foot that can move the way it was designed to.

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